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Background: Lack of appropriate swallow screening is a leading contributor to hospital-acquired pneumonia. To address this problem, Providence Health and Services Oregon Region Stroke Program developed and implemented a BSS in 2005. This tool was designed by a multidisciplinary team to ensure the best evidence-based practice.

Methods: Data from the Providence Stroke Registry collected via Get With The Guidelines were analyzed to determine whether the BSS improved outcomes after implementation in July 2005. Data include all stroke patients admitted to two affiliated Primary Stroke Centers (PSCs) between 2004 and 2013. Hospital-acquired pneumonia rates (HAP) per 100 patient discharges and LOS in days were compared pre (2004- June 2005) and post (July 2005-2013) implementation of the BSS tool using Analysis of Variance Tests. Pre- and post-implementation discharge disposition was compared using Pearson’s chi-square.

Results: Between 2004 and 2013, 10,989 stroke patients were discharged from two PSCs, 1,385 pre-, and 9,604 post- implementation of the BSS. Comparing pre- and post-data, there was a significant decrease in HAP per 100 patient discharges, 7.2 (±25.9) vs 1.9 (±13.6) (p<0.01), and in LOS, 5.1 days (±5.9) vs. 4.4 days (±5.6) (p<0.01). In addition, more patients were discharged home (26.6% vs 19.6%), fewer went to a skilled nursing facility (26.6% vs 19.6%), and fewer expired or went to hospice (15.7% vs. 12.9%) (p<.01).

Conclusion: The Providence Stroke Program Bedside Swallow Screening Tool has provided excellent safety and outcomes for our stroke patients, including lowering risk of HAP. This effect has been sustained over 9 years in over 9600 patients. This is the longest documented ongoing use of a tool for bedside swallow screen. Further studies are needed to determine the relationship between the BSS and other outcomes.